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Digestive Disorders > Intolerances > Gluten Intolerance

Celiac disease symptoms – How do you recognize gluten intolerance?

Dr. med. André Sommer

Dr. med. André Sommer

Celiac disease (synonym: gluten-sensitive enteropathy) is a chronic bowel disease in which there is an intolerance to the protein gluten. If the intestinal mucosa comes into contact with gluten, it becomes inflamed. This causes people with celiac disease to experience characteristic intestinal symptoms. Although sufferers usually suffer from this disease all their lives, the intestinal complaints can be easily treated with a gluten free diet.

Our certified nutritionists can help you with the question of whether there is a connection between your meals and your symptoms. Together with them we have developed a nutritional therapy with which many people have been able to alleviate their symptoms in the long term. Find out in a free initial consultation whether the therapy is suitable for you.

Judging by the number of gluten-free foods in supermarkets, it seems many people suffer from gluten intolerance. Women are affected about two to three times more often than men. Nevertheless, only about one to two people in 1,000 show the classic celiac symptoms. Nevertheless, the gluten-free food market is large. By 2018, sales of gluten-free products are expected to increase from $ 2.5 billion (as of 2010) to over $ 6 billion. Today it is believed that more people suffer from non-celiac wheat sensitivity than from celiac disease, including many people with irritable bowel syndrome. Although they tolerate gluten, they are sensitive to other components of wheat (e.g. FODMAPs). Both symptoms have in common that gluten-free products are better tolerated.

How many people suffer from celiac disease in Germany?

About one in 100 Germans have the genetic predisposition for celiac disease. However, only about 10 to 20 percent of people with a genetic celiac disease also develop typical celiac symptoms. The rest have no or atypical symptoms. Gluten intolerance is lifelong and breaks out in children between the ages of one and eight. It most commonly occurs in adults between the ages of 20 and 50 (age peak).

What are typical celiac symptoms?

People with classic celiac disease who eat foods containing gluten relatively quickly show symptoms of gluten intolerance. These can be avoided with a gluten-free diet. The extent to which symptoms occur with a gluten-containing diet can vary widely. The respective signs can also be different.

The following types of celiac disease are therefore differentiated based on certain symptoms:

  • Classic celiac disease: Classic celiac symptoms appear after eating gluten (e.g. intestinal complaints, deficiency symptoms, weight loss and fat stools)
  • Symptomatic celiac disease: Here, symptoms mainly occur outside the intestine, such as headaches
  • Subclinical celiac disease: There are no symptoms, but the test results are positive
  • Refractory celiac disease: After a period without symptoms, signs appear again or these do not improve despite a gluten-free diet
  • Potential celiac disease: Antibodies specific to celiac disease can be detected in the blood, but the small intestinal mucosa is normal

The following symptoms are typical for classic gluten intolerance:

  • Stomach pain
  • Diarrhea
  • Constipation
  • Flatulence (meteorism / bloating)
  • Vomiting
  • Skin changes (e.g. dermatitis herpetiformis Duhring)
  • Foul-smelling and greasy stool (steatorrhea)
  • Headache or migraine
  • Fatigue
  • Irritability
  • Depressive mood
  • Anemia
  • Weight loss

Is celiac disease dangerous?

Find out your risk with our free self-test - click here.

Yes. If gluten intolerance is not consistently treated by a gluten-free diet or is recognized too late, there may be considerable health restrictions. These are mostly associated with severe inflammation of the intestinal mucosa. This means that the intestine can only absorb nutrients to a reduced extent.

Poorly treated celiac disease increases the risk of deficiency, which can have a negative impact on bone and blood formation. This includes deficiencies in

  • fat-soluble vitamins, which can lead to vitamin K-dependent bleeding and vitamin D-dependent bone softening (rickets, osteomalacia, osteoporosis)
  • Zinc
  • Folic acid
  • Vitamin B12
  • Iron

In addition, gluten intolerance often occurs together with other complaints. This includes:

  • Short stature, developmental disorders and delayed puberty
  • Premature birth
  • Muscle weakness
  • Liver enzyme change (transaminases)
  • Protein deficiency with water retention (protein deficiency edema)
  • Infertility
  • Osteoporosis
  • Night-blindness
  • Autoimmune diseases (type 1 diabetes, thyroid diseases / autoimmune thyroiditis)
  • Intestinal T cell lymphomas
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How is celiac diagnosed?

Various aspects have to be considered for the diagnosis of celiac disease. If possible, the diagnosis should be made before starting a gluten-free diet, otherwise the results may be misleading. The diagnosis of celiac disease includes:

  • Medical history: Celiac symptoms described by the patient, family history, improvement of symptoms after a gluten-free diet
  • Blood tests: Celiac disease serology, elevated transglutaminase IgA antibodies or endomysium IgA antibodies without IgA deficiency
  • Tissue sample: Biopsy of the small intestine before starting the gluten-free diet

Only the tissue sample in combination with the blood test can prove celiac disease and is therefore considered the gold standard of diagnostics. We have developed a free celiac self-test for an initial risk assessment. Click here for the test

In which types of cereals does gluten occur?

Gluten is also called gluten protein, wheat gluten or grain gluten. It is mainly found in the following types of grain:

  • Wheat
  • Rye
  • Spelt
  • Barley
  • Oats
  • Einkorn wheat
  • Emmer
  • Khorasan wheat (Kamut)

How does celiac disease differ from wheat allergy and wheat sensitivity?

The autoimmune disease celiac disease is very similar to the following two diseases, so confusion often occurs. These are:

  • Wheat allergy
  • Non-celiac non-wheat allergy-wheat sensitivity (wheat sensitivity or wheat intolerance)

Celiac disease has in common with wheat allergy and wheat sensitivity that wheat is not tolerated. If the grain is consumed anyway, intestinal complaints similar to nausea, abdominal pain, abdominal cramps, diarrhea or constipation occur. However, the genetic autoimmune disease celiac disease is less common than wheat sensitivity and wheat allergy.

How do wheat sensitivity and wheat allergy differ?

The difference between wheat sensitivity and wheat allergy is that the allergy leads to the formation of specific antibodies (e.g. IgE), which are mostly detectable in the blood. These antibodies are lacking in wheat sensitivity. The antibodies in wheat allergy are directed not against gluten, but against other wheat proteins like gliadins. In addition to the characteristic intestinal symptoms, with wheat allergy the typical signs of an allergic reaction also occur. Swelling or a feeling of scratching (in the mouth, nose, eyes, throat, skin), rashes (urticaria, atopic eczema) and respiratory complaints (asthma, shortness of breath) are characteristic of a wheat allergy.

What distinguishes wheat sensitivity?

Wheat sensitivity is not an allergy. Since there is still no detection method for non-celiac gluten sensitivity, celiac disease and wheat allergy have to be excluded. A food diary (symptom diary) can also help to demonstrate wheat sensitivity. Today it is assumed that, unlike celiac disease, wheat sensitivity is not the incompatible substance. Rather, the wheat protein amylase trysine inhibitor (ATI) and FODMAPs are suspected of being a trigger of wheat sensitivity. Interestingly, the breeding of new grains and the use of corn syrup (glucose-fructose syrup) for sweetening have increased the concentration of ATIs and FODMAPs in our diet. This could be one reason why more and more people are claiming that they no longer tolerate certain grain products.

It is believed that some people with irritable bowel syndrome suffer from wheat sensitivity. In addition to wheat allergy, celiac disease and wheat sensitivity, there is discussion as to whether there is non-celiac gluten sensitivity (NCGS). There is still great disagreement among researchers. It is conceivable that those with a non-celiac gluten sensitivity can be counted among those with wheat sensitivity. The following table shows the differences between celiac disease, wheat sensitivity and wheat allergy.

Difference between celiac disease, wheat sensitivity, wheat allergy

Celiac disease Wheat sensitivity Wheat allergy
Period between food intake and symptoms Weeks to years Hours to days Minutes to hours
Cause Congenital autoimmune disease Sensitivity to FODMAPs or ATIs Allergy to gliadins, amylase trypsin inhibitors, thioredoxin or lipid transfer protein
Blood test Transglutaminase IgA antibody or Endomysium IgA antibody, gene HLA DQ2 / DQ8 No Antibodies against wheat proteins
Enteritis Strong Light Unknown
Diagnosis Small bowel biopsy, tTG-IgA-Ab Exclusion diagnosis, food diary, exposure tests IgE in serum and prick skin test
Frequency 0.9% 1–6% (estimated) More than 1% (estimated)
Nutrition Gluten free (less than 20 milligrams of gluten / kg) Low-FODMAP or low-wheat diet Wheat-free diet

Indications of celiac disease or related sensitivities can be found and treated successfully as part of nutritional therapy. Our special Cara Care program is specially adapted to food intolerances and is also tailored to your symptoms by your personal nutritionist. Learn more about therapy here and arrange a free initial consultation.

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Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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